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Spotting Medicare Fraud

 

Six Ways to Spot Medicare Fraud:

1.  No Medicare drug plan  can ask you for your bank account or other personal information.  There is no fee to enroll in a plan.

2.  No one can come into your home uninvited.  Be suspicious of  ANY home sales.

3.  No one can ask you for your personal information during their marketing activities.

4.  Medicare Part D plan representatives are allowed to call to tell you about their Medicare drug plans.  They may not call to sign you up unless you have called them.

5.  If someone calls to tell you about a plan, ask for the name of his or her company.  Then call Medicare (1800-633-4227) to see if the company is approved by Medicare.

6.  If you suspect fraud, report it.  Call Medicare at 1-800-633-4227 or the US Department of Health and Human Services Fraud Hotline at 1-800-447-8477 or the Federal Trade Commission at 1-877-382-4357.  In Michigan, you can also contact Michigan's Medicare Medicaid Assistance Program (MMAP) at 1-800-803-7174 or the Michigan Attorney General's Office-Consumer Protection Division at 1-877-765-8388.

Note:  The Legal Hotline for Michigan Seniors is also available to Michigan residents age 60 and over, free of charge, to assist them with questions about Medicare and other legal issues.  The Hotline can be accessed Monday through Thursday at 1-800-347-5297.  Attorneys at the Hotline have knowledge and resources to assist clients with a variety of legal issues. 

Social Security Disability Benefits

From the SSAO webpage:  

Benefits For People With

Disabilities

Applying for Benefits?

How to Apply
Disability Starter Kits
Benefits Planner
Forms
Publications

Non-English Languages

Getting Benefits Now?

Direct Deposit
Ticket to Work/Work Incentives
Representative Payment Program


Health Insurance

Medicare/Medicaid Services
Insure Kids Now


Program Information

Electronic Disability Guide (eDG)
Social Security Handbook
Policy/Research
Program/Actuarial Data
Laws & Legislation
Hearings & Appeals
SSA Advisory Board
Facts and Figures

 

Frequently Asked Questions

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.

Social Security Disability Insurance pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes.

Supplemental Security Income pays benefits based on financial need.


When you apply for either program, we will collect medical and other information from you and make a decision about whether or not you meet Social Security's definition of disability.

Use the Benefits Eligibility Screening Tool to find out which programs may be able to pay you benefits.

If your application has recently been denied, the Internet Appeal is a starting point to request a review of our decision about your eligibility for disability benefits.

If your application is denied for:

  • Medical reasons, (beginning December 22nd) you can complete and submit the required Appeal Request and Appeal Disability Report online.

    The disability report asks you for updated information about your medical condition and any treatment, tests or doctor visits since we made our decision.

  • Non-medical reasons, you should contact your local Social Security Office to request the review. You also may call our toll-free number, 1-800-772-1213, to request an appeal. People who are deaf or hard of hearing can call our toll-free TTY number, 1-800-325-0778.

If you have been denied social security disability benefits, contact nurse-attorney, Lori Zellers.  dykemalaw@aol.com

Social Security Disability Appeals

The information below offers basic information about social security disability appeals.  If you have been denied social security disability benefits, call nurse-attorney, Lori Zellers, who has a proven history of winning social security disability appeals.

 

SSA Publication No. 05-10041, January 2008, ICN 459260 [View .pdfGet Accessible Adobe Acrobat Reader (En Español) [Audio.mp3] audio icon

 

Social Security wants to be sure that every decision made about your Social Security or Supplemental Security Income (SSI) claim is correct. We carefully consider all the information in your case before we make any decisions that affect your eligibility or your benefit amount.

When we make a decision on your claim, we will send you a letter explaining our decision. If you do not agree with our decision, you can appeal-that is, ask us to look at your case again.

When you ask for an appeal, we will look at the entire decision, even those parts that were in your favor. If our decision was wrong, we will change it.

Contents

When and how can I appeal?  skip contents list
How many appeal levels are there?
Will my benefits continue?
Can someone help me?
Contacting Social Security
 
 

When and how can I appeal?

If you wish to appeal, you must make your request in writing within 60 days from the date you receive our letter. We assume you receive the letter five days after the date on the letter, unless you can show us you received it later. Call your local Social Security office if you need help with your appeal.

If you filed for Social Security disability benefits or SSI and your claim was denied for medical reasons, you may request an appeal on our website,www.socialsecurity.gov/disability/appeal.

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How many appeal levels are there?

Generally, there are four levels of appeal. They are:

When we send you a letter about a decision on your claim, we will tell you how to appeal the decision.

Reconsideration

A reconsideration is a complete review of your claim by someone who did not take part in the first decision. We will look at all the evidence submitted when the original decision was made, plus any new evidence.

Most reconsiderations involve a review of your files without the need for you to be present. But when you appeal a decision that you are no longer eligible for disability benefits because your medical condition has improved, you can meet with a Social Security representative and explain why you believe you still have a disability.

Hearing

If you disagree with the reconsideration decision, you may ask for a hearing. The hearing will be conducted by an administrative law judge who had no part in the original decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home. The administrative law judge will notify you of the time and place of the hearing.

Before the hearing, we may ask you to give us more evidence and to clarify information about your claim. You may look at the information in your file and give new information.

At the hearing, the administrative law judge will question you and any witnesses you bring. Other witnesses, such as medical or vocational experts, also may give us information at the hearing. You or your representative may question the witnesses.

In certain situations, we may hold your hearing by a video conference rather than in person. We will let you know ahead of time if this is the case. With video hearings, we can make the hearing more convenient for you. Often an appearance by video hearing can be scheduled faster than an in-person appearance. Also, a video hearing location may be closer to your home. That might make it easier for you to have witnesses or other people accompany you.

It is usually to your advantage to attend the hearing (in person or video conference). You and your representative, if you have one, should come to the hearing and explain your case.

If you are unable to attend a hearing or do not wish to do so, you must tell us why in writing as soon as you can. Unless the administrative law judge believes your presence is necessary to decide your case and requires you to attend, you will not have to go. Or we may be able to make other arrangements for you, such as changing the time or place of your hearing. You have to have a good reason for us to make other arrangements.

After the hearing, the judge will make a decision based on all the information in your case, including any new information you give. We will send you a letter and a copy of the judge's decision.

Appeals Council

If you disagree with the hearing decision, you may ask for a review by Social Security's Appeals Council. We will be glad to help you ask for this review.

The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review.

If the Appeals Council denies your request for review, we will send you a ­letter explaining the denial. If the Appeals Council reviews your case and makes a decision itself, we will send you a copy of the decision. If the Appeals Council returns your case to an administrative law judge, we will send you a letter and a copy of the order.

Federal Court

If you disagree with the Appeals Council's decision or if the Appeals Council decides not to review your case, you may file a ­lawsuit in a federal district court. The letter we send you about the Appeals Council's action also will tell you how to ask a court to look at your case.

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Will my benefits continue?

In some cases, you may ask us to ­continue paying your benefits while we make a decision on your appeal. You can ask for your benefits to continue when:

  • You are appealing our decision that you can no longer get Social Security ­disability benefits because your medical condition is not disabling; or
  • You are appealing our decision that you are no longer eligible for SSI payments or that your SSI payment should be reduced or suspended.

If you want your benefits to continue, you must tell us within 10 days of the date you receive our letter. If your appeal is turned down, you may have to pay back any money you were not eligible to receive.

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Can someone help me?

Yes. Many people handle their own Social Security appeals with free help from Social Security. But you can choose a lawyer, a friend or someone else to help you. Some­one you appoint to help you is called your "representative." We will work with your representative just as we would work with you. Your representative can act for you in most Social Security matters and will receive a copy of any decisions we make about your claim.

Your representative cannot charge or ­collect a fee from you without first getting written approval from Social Security. If you want more information about having a representative, ask for Your Right To Representation (Publication No. 05-10075) or you can find it on our website.

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Contacting Social Security

Our website is a valuable resource for information about all of Social Security's programs. There are a number of things you can do online.

In addition to using our website, you can call us toll-free at 1-800-772-1213. We treat all calls confidentially. We can answer specific questions from 7 a.m. to 7 p.m., Monday through Friday. We can provide information by automated phone service 24 hours a day. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.

We also want to make sure you receive accurate and courteous service. That is why we have a second Social Security representative monitor some telephone calls.

Intro to Social Security Disability

 

 

If you believe you are disabled and you cannot work, you should consider social security disability benefits.  Read on.... 

 

Disability is something most people do not like to think about. But the chances that you will become disabled probably are greater than you realize. Studies show that a 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching retirement age.

This booklet provides basic information on Social Security disability benefits and is not intended to answer all questions. For specific information about your situation, you should talk with a Social Security representative.

We pay disability benefits through two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program. This booklet is about the Social Security disability program. For information about the SSI disability program for adults, see Supplemental Security Income (SSI) (Publication No. 05-11000). For information about disability programs for children, refer to Benefits For Children With Disabilities (Publication No. 05-10026). Our publications are available at www.socialsecurity.gov.

If you have been denied social security benefits, contact experienced social security attorneys at Dykema Law Offices, P.C.  Servicing all of West Michigan.

616 363-6611 

 

Should I apply for social security disability benefits?

As you get older, it gets easier to be found disabled.  If you are over the age of 55 and you are unable to do a job that you have done within the past 15 years, you would be a good candidate for benefits. 

If you are over 50 years of age and you have a severe impairment which keeps you from doing anything but simple jobs, you should also apply. 

You don't necessarily have to be confined to a wheelchair or a bed to be considered disabled, even if you are younger.  If you are under the age of 50 and you are unable to do jobs that you've had in the past and you cannot work at any regular job on a full-time basis, you should apply.

Note that being unable to work and being disabled under the social security administration standards  are two very different things.  It is often hard to prove you are disabled just because you are unable to work. 

Bottom line is that if you are unable to work, you should apply for SSD disability benefits.  Even if denied, you should keep appealing all the way to an administrative judge.  If you've been denied benefits by an administrative judge, you should then seek legal help.

Dykema Law has an experienced social security disability attorney who is also a registered nurse with many years of medical experience.  She is able to review your case and determine if there is a way to pursue and win your case before the Appeals Council

Call for an appointment today:  616.363.6611

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